Psychiatric Code Changes. Agenda 1/30/2013

Transcription

1 February 2013 Jean C. Russell, MS, RHIT Richard Cooley, BA, CCS Agenda 2013 Psychiatric Codes Deleted Codes New Codes Changed Codes Add-on codes Documentation Requirements Modifiers OMH-Specific Requirements 3 Psychiatric Code Changes The psychiatric CPT codes have been restructured to capture the dramatic changes in the way psychotherapy services are provided since the inception of these codes into the CPT code set in 1998 (CPT Coder s Inside View, 2013) 1

2 4 Deleted Codes 5 New Codes Interactive Complexity Add-on code ( + ) 90785, Interactive complexity (separate in addition to primary procedure) + Reported when the services are performed using interactive techniques Packaged under APCs 2

3 Interactive Complexity Reported with another code when at least one of the following is present: Maladaptive communication (e.g., high anxiety, high reactivity, repeated questions or disagreement) Emotional or behavioral conditions inhibiting implementation of treatment plan Mandated reporting/event exists (e.g., abuse or neglect) or Play equipment, devices, interpreter, or translator required due to inadequate language expression or different language spoken between patient and professional 8 Psychiatric Dx Interview Deleted Codes: 90801, Psych Dx Eval, and 90802, Interactive Psych Dx Eval Replacement/New Codes: 90791, Psychiatric dx evaluation, and 90792, Psychiatric dx evaluation with medical services Or, alternatively report clinic E/M codes ( ) is designed for reporting by a psychiatrist There are limitations to the frequency in which these codes can be reported to both Medicare and Medicaid (LCD for Psychiatry and Psychology Services (L26895)) To report interactive psych dx evaluation, add the code 90785, Interactive complexity (separate in addition to primary procedure) +, to either procedure 9 Psychiatric Dx Interview 3

4 10 OP Psychotherapy Time now includes time with patient and/or family patient must be present for at least part of the time Time calculated using CPT time rule Psychotherapy w/ E/M is an add-on code ( + ) It is reported w/ the standard E/M codes plus the psychotherapy code For reporting by a psychiatrist Medicare E/M technical/facility level based on hospital technical E/M guidelines 11 Deleted Codes: OP Psychotherapy Psychotherapy office min Psychotherapy office min w/ E/M Psychotherapy office min Psychotherapy office min w/ E/M Psychotherapy office min Psychotherapy office min w/ E/M Replacement/New Codes: 90832, Psychotherapy, 30 min w/ patient and/or family member 90833, Psychotherapy, 30 min w/ patient and/or family member w/ E/M , Psychotherapy, 45 min w/ patient and/or family member 90836, Psychotherapy, 45 min w/ patient and/or family member w/ E/M , Psychotherapy, 60 min w/ patient and/or family member 90838, Psychotherapy, 60 min w/ patient and/or family member when performed with an E/M (separate in addition to primary procedure) + 12 CPT Time Per CPT A unit of time is attained when the midpoint is passed. For example, an hour is attained when 31 minutes have elapsed (more than midway between zero and sixty minutes). A second hour is attained when a total of 91 minutes have elapsed. (source: Page xii, Introduction, CPT Professional Edition, 2013) 90832/ minutes is minutes 90834/ minutes is minutes 90837/ minutes is 53+ minutes 4

5 13 Psychotherapy with E/M Time Time associated with activities used to meet criteria for the E/M service is not included in the time used for reporting the psychotherapy services (i.e., time spent on history, examination and medical decision making when used for the E/M service is not psychotherapy time). Time may not be used as the basis of E/M code selection and prolonged services may not be reported when psychotherapy with E/M (90833,90836,90838) are reported (source: Page 485, Introduction, CPT Professional Edition, 2013) 14 OP Psychotherapy 15 Interactive Psychotherapy Deleted Codes: Interactive psychotherapy office min Psychotherapy office min w/ E/M Psychotherapy office min Psychotherapy office min w/ E/M Psychotherapy office min Psychotherapy office min w/ E/M Replacement/New Codes (same codes, same rules): 90832, Psychotherapy, 30 min w/ patient and/or family member 90833, Psychotherapy, 30 min w/ patient and/or family member w/ E/M , Psychotherapy, 45 min w/ patient and/or family member 90836, Psychotherapy, 45 min w/ patient and/or family member w/ E/M , Psychotherapy, 60 min w/ patient and/or family member 90838, Psychotherapy, 60 min w/ patient and/or family member when performed with an E/M (separate in addition to primary procedure) + And 90785, Interactive complexity (separate in addition to primary procedure) + 5

6 16 Interactive OP Psychotherapy 17 Medication Management Deleted Code: Pharmacologic management, including prescription, use, and review of medication with minimal psychotherapy Retained Code: M0064 Brief office visit for the sole purpose of monitoring or changing drug prescriptions used in the treatment of mental psychoneurotic and personality disorders Replacement/New Codes: , Clinic E/M Visit Codes , ER E/M Visit Codes , Other E/M Visit Codes , Other E/M Visit Codes 18 Medication Management New Challenges: was a common service reported for psychiatrists Now they will need to report an E/M code This will require they understand E/M professional coding guidelines, likely the 1997 since there is a psychiatric specific exam guideline This will also require technical E/M guidelines for reporting to Medicare in hospital-based clinics The reporting requirements for OMH vary from Medicare and other Commercials, thereby creating other fun challenges 6

7 19 Other Codes remained unchanged interactive group therapy, is now the standard group therapy code (90853) plus the add-on for interactive therapy (90785) 20 Psychiatric Crisis Two new codes for psychiatric crisis treatment Urgent assessment and history in a crisis state Not reported in addition to other codes, time includes the total duration of face-to-face with patient and/or family Provider must devote full attention to the patient Patient must be present for some or all of the service Psychotherapy for crisis; first 60 min (note CPT time starts at 31 minutes) Psychotherapy for crisis; each add l 30 min (separate in addition to primary procedure) + 21 Modifiers The following modifiers may be required for these services (does not include OMH-specific modifiers) - 25 significant, separately identifiable medical visit - 27 multiple outpatient hospital E/M encounters on the same date of service - 59 distinct procedure - FB Injectable drug provided at no cost to the hospital 7

8 22 23 Modifiers Modifiers reportable to OMH OMH does not split bill like other Medicaid services performed by physicians in hospital-based clinics There are a series of three modifiers reported with certain codes to indicate the services are eligible for the physician add-on payment Eligible for AF - Psychiatrist physician add-on (i.e., AG Physician, non psychiatrist AF psychiatrist AG physician SA psych nurse SA Psychiatric nurse practitioner practitioner 24 Modifiers Language other than English Modifier U4 The use of language assistance services and the method of providing the service should be documented in a progress note Adds an additional 10% to the APG portion of the payment Replaces the add-on code is not used by OMH source: NEW YORK STATE OFFICE OF MENTAL HEALTH, 14 NYCRR Part 599, Clinic Treatment Programs, Interpretive/Implementation Guidance,

9 25 26 Psychotherapy Psychotherapy codes that OMH accepts: 90832, Psychotherapy, 30 min w/ patient and/or family member 90833, Psychotherapy, 30 min w/ patient and/or family member w/ E/M , Psychotherapy, 45 min w/ patient and/or family member 90836, Psychotherapy, 45 min w/ patient and/or family member w/ E/M + Psychotherapy codes that OMH does not accept: 90837, Psychotherapy, 60 min w/ patient and/or family member 90838, Psychotherapy, 60 min w/ patient and/or family member when performed with an E/M (separate in addition to primary procedure) + 27 Crisis Crisis codes that OMH accepts: H2011, Crisis Intervention, brief, per 15 min S9484, Crisis Intervention, complex, one hour minimum S9485, Crisis Intervention, per diem, three hour minimum Crisis codes that OMH does not accept: Psychotherapy for crisis; first 60 min Psychotherapy for crisis; each add l 30 min (separate in addition to primary procedure) + 9

10 28 Medication Injection Codes Codes that OMH accepts: 96372, SQ/IM injection Billed as referred amb, no rate code, not paid on APGs H2010, Injectable Psychotropic Medication Administration with Education and Monitoring, 15 minute minimum Billed with a rate code, paid on APGs 29 Medication Management is no longer valid Replacement codes are E/M codes Except, OMH will accept E/M codes or Psychotropic medication treatment APC status E for Medicare (not reportable) APG relative weight varies from that for the E/M diagnosis APGs Will need to decide which code to report to OMH, but must be mapped to an E/M for Medicare and other payers 30 Other Codes to Keep in Mind After Hours Applicable when services are provided weekdays before 8 AM, weekdays 6 PM or later, or all day on weekends, must begin before 8:00 a.m. or 6:00 p.m. or later Health monitoring and Smoking cessation counseling HQ Group smoking cessation counseling H0049/H0050 Alcohol / drug screening Complex care management 10

11 31 Questions and Discussion 32 Richard Cooley Contact Us Phone: Jean Russell Phone:

12 34 CPT Current Procedural Terminology (CPT ) Copyright 2012 American Medical Association All Rights Reserved Registered trademark of the AMA 35 Disclaimer Information and opinions included in this presentation are provided based on our interpretation of current available regulatory resources. No representation is made as to the completeness or accuracy of the information. Please refer to your payer or specific regulatory guidelines as necessary. 12